Insurance Claims For Your Sleep Apnea and Oxygen Supplies
RespShop does not directly accept insurance of any kind. Medicare may reimburse you for your purchase, but it is best to check with them first.
CPAP machines, masks, humidifiers, oxygen concentrators, including stationary and portable, and all related parts are classified as Durable Medical Equipment (DME) by insurance companies. Medicare and most health insurance companies may reimburse you for CPAP equipment, supplies, and other durable medical equipment purchased from RespShop.
We strongly recommend you contact your insurance company before purchase.
Insurance policies differ so much that it is best to know what your financial obligation is upfront. Contacting your insurance company before buying also lets you find out if there are insurance company- specific documentation needs you must comply with when submitting your claim for reimbursement. Some companies, for example, will require not just your invoice but also a copy of your actual prescription.
Your policy may reimburse only a certain percent of the cost or have a required co-pay amount. Medicare, for example, typically pays for 80% of CPAP equipment and you are responsible for the additional 20%.
Out of pocket purchasing often makes the most sense. Some policies have high deductibles that must be met before any eligibility for reimbursement. In those cases, you can make an informed decision about whether paying out of pocket or filing an insurance claim is the smartest financial decision for you. People with a high deductible or a high co-pay obligation often find that paying out of pocket for CPAP equipment is the most cost-effective and friction-free approach.
Health Savings Accounts (HSA)
Do you have a Health Savings Account (HSA)? CPAP machines, masks, supplies and other related equipment are eligible for HSA purchasing. For reimbursement through your HSA, you just need to submit your RespShop invoice.
Some HSA companies issue credit cards and you can purchase with that card to avoid paperwork. Keep your invoice, however, in case the HSA audits your purchase.
Questions to ask your insurance provider before buying– Read Full Article Here
It is advised that you contact your Insurance provider prior to billing your claim. Most insurance companies will cover the cost of your CPAP/BiPAP machine and supplies with appropriate documentation. Some Insurances will not accept paper claims and therefore will only accept an electronic claim. Be sure to confirm with your insurance company these questions.
- May I purchase the CPAP machine and still have it covered?
- Is Respshop in network or will I be paying out of pocket for this claim?
- Is pre-authorization required?
- Do you accept a paper claim?
- What documentation will I need to send with my claim?
- Will I need to add any modifiers to my claim?
- What percent of the cost of the CPAP equipment is reimbursable?
- What deductible or co-pay amount must be met before I am eligible for any reimbursement?
Filing for reimbursement
- Get the claim form here. If your insurance company has not already sent you a form to use, RespShop has forms for major carriers. At the bottom of the page (or click here), you will find links to claim forms for Medicare and other major insurance companies. Print the form, fill it out, and send it along with your RespShop invoice to the address listed on the back of your health insurance card. If your company is not listed, request the form from them or use the Universal Claim form listed under the link to "Other Insurance Providers".
- Print your invoice from RespShop. Your invoice will contain many details for the claim form, including an ICD-10 code, a HCPCS code, and a tax ID number.
- Fill out the form.
- If the form asks for a diagnosis code, enter the ICD-10 code from your invoice.
- If the form asks for a procedure code, enter the HCPCS code from your invoice.
- The form may request an NPI number. NPI stands for National Provider Identifier.
- Submit the form. Send the completed reimbursement along with your RespShop invoice and any other documents your insurance company requested to the address listed on the back of your health insurance card. Submit your claim for reimbursement as soon as possible. Insurance companies often limit reimbursement to events that occurred within one year.
- Blue Cross / Blue Shield
- Kaiser Permanente
- United Healthcare
- Other Insurance Providers
Glossary of Insurance Terms:
Co-pay: The amount an insured person must contribute out of pocket toward the cost of care or a medical supply. CPT: Current Procedural Terminology. A type of procedure code for medical billing. Deductible: The amount of money that a person must spend out of pocket before their insurance starts to cover expenses. DME: Durable Medical Equipment. Insurance-speak for medical supplies that are not meant to be disposed of after one use. CPAP masks, CPAP machines, and CPAP humidifiers are durable medical equipment. HCPCS: Healthcare Common Procedure Coding System. This is a procedure code for medical billing. NPI: National Provider Identifier. RespShop's NPI number is 1831715739.